Multimodal imaging in infectious and noninfectious intermediate, posterior and panuveitis.

PURPOSE OF REVIEW: Given the heterogeneity of uveitis, markers of inflammation vary from patient to patient. Multimodal imaging has proven itself to be critical for accurate evaluation for disease activity and treatment response in uveitis. RECENT FINDINGS: Ultra-widefield (UWF) fluorescein angiography and autofluorescence (AF) as well as optical coherence tomography angiography (OCTA) have provided insights into disease pathogenesis and monitoring not previously appreciated. In addition to structural retinal imaging, OCT can be used to assess the choroid, the posterior cortical vitreous and the retinal vasculature in eyes with uveitis. SUMMARY: Multimodal ocular imaging in eyes with uveitis is critical for disease diagnosis and assessing response to treatment. UWF fluorescein angiography can detect retinal vasculitis even in the absence of overt vascular sheathing. UWF AF can help detect more chorioretinal lesions than clinically visible. OCT can be used to assess the posterior cortical vitreous, retina, large retinal vessels and choroid in uveitis. The use of multimodal imaging will likely be needed to determine clinical trial endpoints in studies evaluating therapeutics for uveitis.

Discrepancy in Fluorescein Angiography and Optical Coherence Tomography Findings of Macular Edema in Intermediate Uveitis.

PURPOSE: To assess discrepancies between fluorescein angiography (FA) and optical coherence tomography (OCT) findings for macular edema (ME) in intermediate uveitis, and investigate treatment response differences corresponding to the discrepant patterns. METHODS: Discrepant results for ME detection between FA and OCT were evaluated. After 6 months, differences in treatment responses were analyzed. RESULTS: Discrepant findings for ME were found in 21 (44%) of 48 eyes. The best-corrected visual acuity significantly improved after treatment in the concordant group but not in the discrepant groups. Central retinal thickness significantly decreased after treatment in the FA+/OCT+ and FA-/OCT+ groups but not in the FA+/OCT- group. Disease duration was significantly longer in the FA+/OCT- group than in the other groups. CONCLUSIONS: Discrepancies in FA and OCT findings for ME were common in patients with intermediate uveitis. Our results suggest that treatment outcomes may differ according to the discrepant patterns.

[Evolution of nodular scleritis with ultrasound biomicroscopy: case report]. / Evolução da esclerite nodular com biomicroscopia ultrassônica: relato de caso.

To establish evolutionary pattern of a case of nodular scleritis with high frequency ultrasound during treatment. Twenty-seven year old female, initial manifestation of intermediate uveitis, bilateral macular edema after clinical treatment with topical and oral steroids. After four months, we observed the formation of a scleral nodule in the right eye when patient underwent high frequency ultrasound (Paradigm, 50 MHz transducer, immersion technique). The lesion in right eye was characterized at high frequency ultrasound as a nodular lesion located at the anterior inferior temporal wall associated with localized reduction of scleral thickness. After intravitreal injection of triamcinolone for treatment of macular edema, clinical regression of the scleral nodule was observed in right eye, maintaining reduced scleral thickness. High frequency ultrasound assisted in the diagnosis of nodular scleritis during the phases of treatment and in the identify its characteristic sequel feature, the scleral thinning.

Combined 50- and 20-MHz frequency ultrasound imaging in intermediate uveitis.

PURPOSE: To evaluate the information provided by multifrequency ultrasound examination in patients with intermediate uveitis. DESIGN: Prospective observational case series. METHOD: High-resolution ultrasonography with 50- and 20-MHz frequency immersion probes was performed in seven eyes of five young patients with clinical diagnosis of intermediate uveitis. RESULTS: Exudative material over the inferior pars plana and peripheral retina (snowbank) was found in all eyes with 50- and 20-MHz probe, although resolution of the latter was poorer. The 50-MHz imaging was superior for visualization of angle structures and details of pars planitis; the anterior vitreous involvement and cyclitic bands were better shown with the 20-MHz probe, which could also evidence cystoid macular edema. CONCLUSIONS: Ultrasound examination with both 50- and 20-MHz frequency probes can detect the typical snowbank in intermediate uveitis and be useful in eyes with small pupil, dense vitreitis, or both, especially before pars plana vitrectomy or cataract surgery.

[Ultrasound biomicroscopy in intermediate uveitis].

OBJECTIVE: To investigate the character of intermediate uveitis by ultrasound biomicroscopy (UBM) and determine the potential and usefulness of UBM as a diagnostic procedure in intermediate uveitis. METHODS: Twenty-one cases (35 eyes) of intermediate uveitis were diagnosed by slit lamp biomicroscopy and indirect binocular ophthalmoscopy with scleral indentation. UBM was performed on 35 eyes of 21 patients with intermediate uveitis in order to determine the configuration of pars, plana peripheral retina and vitreous. RESULTS: In 31 of 35 eyes, pathological structures such as spotted or membraneous vitreous condensations, vitreoretinal adhesions with traction on the peripheral retina and ciliary body detachment were identified by UBM. In four eyes, no abnormalities were identified by UBM. CONCLUSION: UBM seems to be a valuable diagnostic technique for the evaluation of patients with intermediate uveitis.

Ultrasound biomicroscopic imaging in intermediate uveitis.

BACKGROUND: Clinical examination of the region of the eye mainly affected in patients with intermediate uveitis is difficult and often hampered by media opacities. In that perspective ultrasound biomicroscopy (UBM) promises to be a valuable additional diagnostic tool. METHODS: UBM was performed at a sound frequency of 50 MHz on 26 eyes of 13 patients with intermediate uveitis in order to determine configuration of pars plana, peripheral retina, and vitreous. Findings of ophthalmoscopy with scleral indentation and UBM were compared. RESULTS: In 18 of 26 eyes pathological structures such as membraneous or fluffy vitreous condensations were identified by UBM. Among these UBM revealed pathological findings which were not visible on funduscopy in nine eyes. Most importantly, vitreoretinal adhesions with traction on the retina were imaged in four eyes. However, in three eyes vitreous opacities being visible on funduscopy were not identified by UBM. CONCLUSION: UBM seems to be a valuable diagnostic technique for the evaluation of patients with intermediate uveitis. Longitudinal studies will have to determine the relevance of UBM findings for the individual clinical course and their influence on therapeutic decisions.

[Bilateral intermediate uveitis and acute interstitial nephritis (TINU syndrome). Ultrasonographic documentation of a case]. / Uvéite intermédiaire bilatérale et néphrite interstitielle aiguë (TINU syndrome). Documentation échographique d'un cas.

Clinical features and natural course of acute interstitial nephritis and uveitis (TINU Syndrome) in a 9 years old boy are reported. The patient's ocular symptoms began seven month after the renal disease was diagnosed. Intermediate uveitis was present bilaterally with vitreous infiltration. Optic disc drusen were documented by echography. An immunological disorder causing the syndrome is most likely, as some laboratory data demonstrate. No systemic or infectious diseases were found in our case but an etiology to drugs considered likely.

[Value of vitrectomy in intermediate uveitis and Behçet's disease with hyalitis. A study of 400 cases]. / Intérêt de la vitrectomie dans les uvéites intermédiaires et la maladie de Behçet avec hyalite. Etude sur 400 cas.

Can vitrectomy help to understand the vitreous role in intermediate uveitis and Behçet's disease with vitritis without retinal detachment? 400 vitrectomies were decided because of vitreous changes but, over all, if macular changes were seen clinically or on the angiogram in 58 Behçet's disease and 342 intermediate uveitis including 59 children cases. Visual acuity, clinical, angiographical and visual field controls, recurrences, reduction of the medical treatment and growth were followed during 1 to 9 years. The vitrectomy products were compared to those of other inflammatory origin vitreous, the both representing 149 cases. Vitrectomy at the early stage of only posterior interface changes prevent the macular edema but this one is irreversible. The preexisting angiographical lesions have not regressed but they are generally quiet. The RD incidence is lower even if it is possible after vitrectomy, in 1.2% of the cases (1% in late vitrectomies). Recurrences and further medical treatment are reduced. This psychological point of view is important. Thus, vitrectomy at alone posterior interface change stage avoid ocular complications. Its pathogenic role in intermediate uveitis is not demonstrated; it seems more a secondary than a primary process.